SAMBA: Leading the Ambulatory March Into the Future

mbulatory anesthesiology is the fastest growing subspecialty in clinical anesthesiology. A wide range of increasingly invasive procedures are being performed on medically complex patients in an ambulatory setting. It has been estimated that 70 percent to 80 percent of all surgery in the United States is performed on an outpatient basis. Furthermore there has been significant growth of office-based procedures, which have approached 25 percent of outpatient procedures. This fact has imposed a significant demand for highly efficient and streamlined care upon ambulatory and office-based anesthesia practitioners.

The Society for Ambulatory Anesthesia (SAMBA) has responded to the dynamic changes in the practice of ambulatory and office-based anesthesia and has contributed to its growth and influence through education, research and scientific progress. Education has been at the forefront of SAMBA’s mission and is achieved through the sponsorship of an annual meeting each spring and a mid-year meeting each fall (held just before the ASA Annual Meeting). These meetings provide outstanding, comprehensive and in-depth educational programs. The SAMBA meetings also provide ample opportunity to meet and interact with experienced private and academic practitioners who share common interests. In addition SAMBA supports ASA programs in ambulatory anesthesiology, which include participation in the Scientific Content Subcommittee on Ambulatory Anesthesia track that determines the educational content for the ASA Annual Meeting. This committee is chaired by SAMBA Past President Barbara S. Gold, M.D. All members of this committee are also SAMBA members.

Another educational effort of SAMBA is the quarterly publication of a print newsletter that addresses controversies in practice and policy as well as trends and issues that transcend the practice of ambulatory anesthesiology. In addition SAMBA’s monthly eNewsletter, which can be accessed on the SAMBA Web site www.sambahq.org provides the latest scientific research and practical advances relevant to our practice. The Literature Review Section of the eNewsletter presents members with abstracts of articles relevant to ambulatory and office-based practice that are published in five major anesthesiology journals. The eNewsletter’s Discussion Section solicits questions and issues from members and elicits responses from a diversified membership from community practice and academia, hospital-based and freestanding ambulatory surgery units, and adult and pediatric practices. In addition to its educational efforts, SAMBA has supported research, including two outcomes research grant awards, a benchmarking project and a joint research fellowship grant with the Foundation for Anesthesia Education and Research.

These are exciting times for SAMBA, as a number of new initiatives have been undertaken. These initiatives include a benchmarking project and the fellowship accreditation project. With increased emphasis on improvement in quality of care at lower costs, there is a demand for evidence-based medical practice and regulation of health care delivery. Unfortunately there is a lack of data regarding outcomes and patterns of ambulatory anesthesia practice, which makes it difficult to provide evidence that patient care is consistently appropriate, safe and cost-effective. There is a concern that such a paucity of information may result in arbitrary selection of pay-for-performance metrics. The officers and members of SAMBA have realized the need for determination of appropriate meaningful outcomes and service indicators. To this end, the SAMBA Board of Directors appointed a Task Force on Benchmarking to develop an Internet-based database registry (SAMBA Clinical Outcomes Registry [SCOR]) that would offer practitioners and facilities measurement outcomes and compare those anonymously with others. There also is a proposal to form a new Committee on Clinical Outcomes and Performance Measures, which will be chaired by Lucinda L. Everett, M.D., a past president of SAMBA.

Because residents are the future of SAMBA, a Subcommittee on Resident Section was formed to promote development in the residents who will become leaders in ambulatory anesthesiology. In addition SAMBA encourages resident involvement by underwriting resident travel awards for presentation of research at the SAMBA Annual Meeting. To encourage specialization in the field of ambulatory anesthesiology, SAMBA provides educational guidelines for subspecialty training in ambulatory anesthesia, which includes an extensive annotated bibliography that also would assist practitioners in dealing with all aspects of perioperative care. Most anesthesiology residents are not exposed to office-based anesthesia practice, and they rarely have the opportunity to develop competency in leadership, management and organizational skills required of the physician executive; such skills are essential since the anesthesiologist is usually placed in a leadership role in most ambulatory facilities. It also is essential that these leaders have orientation in conducting research.

Rarely, however, do residents have the opportunity to design and complete a project during the three-year residency. Several institutions recognize these deficiencies and offer ambulatory anesthesiology fellowships. These programs are not recognized by the Accreditation Council for Graduate Medical Education (ACGME) though, and therefore may lack standardization of training. In an effort to guarantee a consistent and comprehensive educational experience, the members of the SAMBA Board of Directors established a Task Force on Accreditation of Ambulatory Anesthesia Fellowships. The task force is chaired by Shireen Ahmad, M.D., who is currently chair of the SAMBA Education Committee and co-chaired by Lydia A. Conlay, M.D., Ph.D., M.B.A., another SAMBA past president. In addition to clinical aspects, the one-year fellowship curriculum includes administrative topics and a significant research component. It is expected that the final application to the ACGME/Residency Review Committee will be submitted later in the year, following the deliberations of the task force and input from the general membership of the Society.

SAMBA continues to interact with other professional organizations and regularly participates in the development and promotion of policies and programs related to ambulatory and office-based anesthesia practice. SAMBA provides representation to a number of professional organizations, including the Accreditation Association for Ambulatory Health Care, the Joint Commission’s Ambulatory Health Care Professional and Technical Advisory Committee and the National Patient Safety Foundation. Recently SAMBA Immediate Past President Walter G. Maurer, M.D., past President Beverly K. Philip, M.D., and President Girish P. Joshi, M.D., represented SAMBA at a Summit Conference on Patient Safety in the Office-Based Surgery Setting (OBS) held in Chicago, Illinois. It was funded by a grant from the Agency for Healthcare Research and Quality (AHRQ) and attended by representatives of four accreditation organizations and representatives of a number of professional societies. The goals of the conference were to assess the current level of accreditation of OBS settings and the impact of accreditation on patient safety, to emphasize the need for evidence-based reporting to address safety issues, and to create a series of initiatives that would improve collaboration between the accrediting agencies as a strategy for improving patient safety in OBS practice. Overall, the conference was very positive with significant interest from all attendees in improving patient safety in the OBS setting. It was generally agreed that there is a lack of data showing that accreditation of OBS practices enhances patient safety. Thus the accrediting agencies were given the charge to work together to collect such data. In addition it was suggested that the accreditation organizations and professional associations should join hands in advocacy and educational activities emphasizing the need for accreditation of OBS practices.

SAMBA has an international influence through its representation to overseas organizations such as the International Association of Ambulatory Surgery (IAAS) and participation in international conferences. The Committee on Latin American Relations provides a Spanish newsletter editor for online publication of the Spanish version of the SAMBA newsletter. Efforts have been made to provide “observer-ships” or mini-fellowships to our Latin American colleagues. In addition there are plans to expand these international partnerships and collaborations to the Asia-Pacific region (e.g., China, Japan, Korea, Thailand, Malaysia, Singapore, Philippines and India).

SAMBA is a vibrant Society with significant involvement from its members, officers and past presidents. It is the leading medical society for education and research in ambulatory and office-based anesthesiology that is dedicated to improving patient care. The accomplishments of SAMBA continue, and so does the value of SAMBA membership.

Girish P. Joshi, M.D., M.B.B.S., is Professor of Anesthesiology and Pain Management, Director, Perioperative Medicine and Ambulatory Anesthesia, University of Texas Southwestern Medical Center at Dallas, Texas.